Reviewed on 6/21/2023

What Is Protriptyline and How Does It Work?

Protriptyline is a prescription medication used for the treatment of depression.

  • Protriptyline is available under the following different brand names: Vivactil

What Are Side Effects Associated with Using Protriptyline?

Common side effects of Protriptyline include:

  • anxiety
  • agitation
  • apathy
  • anorexia
  • nausea
  • headache
  • diarrhea
  • constipation
  • urinary retention
  • dizziness
  • restlessness
  • insomnia (decrease of REM sleep)
  • nightmares
  • hypotension
  • hyponatremia
  • diaphoresis
  • itching
  • rash
  • blurred vision
  • dry mouth
  • impotence
  • change of libido
  • difficulty having an orgasm
  • suicidal thoughts and suicide attempts and risk, especially in those younger than 24 years old, is greater during the initial two months of starting the drug and during dosage adjustment

Serious side effects of Protriptyline include:

Rare side effects of Protriptyline include:

  • None

Seek medical care or call 911 at once if you have the following serious side effects:

  • Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
  • Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
  • Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

What Are Dosages of Protriptyline?

Adult and pediatric dosage


  • 5 mg
  • 10 mg


Adult dosage

  • 15-60 mg/day orally divided every 6 to 8 hr; not to exceed 60 mg/day

Pediatric dosage

  • Children aged younger than 12 years: Safety and efficacy not established
  • Children aged 12 years and older: 15 to 20 mg orally every day

Geriatric dosage

  • 5 mg orally every 8 hours initially; increase by 5 to 10 mg every 3 to 7 days or as needed; cardiovascular adverse effects may increase if doses exceed 20 mg/day

Dosage Considerations – Should be Given as Follows:

  • See “Dosages”

What Other Drugs Interact with Protriptyline?

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

  • Protriptyline has severe interactions with the following drugs:
    • disopyramide
    • ibutilide
    • indapamide
    • iobenguane I 123
    • isocarboxazid
    • pentamidine
    • phenelzine
    • pimozide
    • procainamide
    • procarbazine
    • quinidine
    • safinamide
    • selegiline
    • sotalol
    • tranylcypromine
  • Protriptyline has serious interactions with at least 141 other drugs
  • Protriptyline has moderate interactions with at least 347 other drugs
  • Protriptyline has minor interactions with at least 71 other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions, or concerns.

What Are Warnings and Precautions for Protriptyline?


  • Hypersensitivity
  • Severe cardiovascular disorder
  • Narrow-angle glaucoma
  • Within 14 days of MAOIs (risk of serotonin syndrome); if linezolid or IV methylene blue (MAOIs) must be administered, discontinue the serotonergic drug immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring, whichever comes first
  • Any drugs or conditions that prolong QT interval
  • Acute recovery post-MI

Effects of drug abuse

  • None

Short-Term Effects

  • See “What Are Side Effects Associated with Using Protriptyline?”

Long-Term Effects

  • See “What Are Side Effects Associated with Using Protriptyline?”


  • Caution in BPH, urinary/GI retention, hyperthyroidism, open-angle glaucoma, seizure disorder, brain tumor, respiratory impairment
  • Clinical worsening and suicide ideation may occur despite medication
  • Risk of anticholinergic side-effects
  • Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

Pregnancy and Lactation

  • Use with caution if benefits outweigh risks during pregnancy
  • Lactation
    • Avoid

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